Hyperhidrosis - Symptoms & Treatment

Normal sweating, or perspiration, is something all humans do to regulate their core body temperatures. Another word that means 'to sweat' is hydrosis, and when we join that word with the prefix 'hyper' which means doing anything to excess, excessively, or above normal, we get the combined word hyperhidrosis.

Hyperhidrosis, spelled phonetically as hi-pur-hi-DROE-sis, is excessive sweating, and affects 1%-3% of the population. Normal sweating occurs naturally when we exercise or our bodies are heated, and that same normal sweating cools us off. But, excessive sweating is abnormal, if not necessarily related to heat or exercise, and can be embarrassing and unhelpful. The mechanism of sweating is controlled by the sympathetic nervous system which manages our bodies' reactions to stress, fight-or-flight reflexes, and similar emergencies. Our sympathetic nervous system uses the chemical acetylcholine to activate the sweat glands, and people with hyperhidrosis are especially sensitive to this chemical signal, making them produce several times more sweat than normal. Hyperhidrosis can seem to run in families, but the medical community continues to research the underlying causes of hyperhidrosis. Many people with hyperhidrosis can have lowered self-esteem because the effects of the abnormal sweating can cause anxiety, hinder daily activities, stain clothes, impact social interactions, and negatively affect the overall quality of a person's life. This article will explain hyperhidrosis below in greater detail, but a broad list of different ways that medical doctors describe the skin disease by differing types are:

• Primary hyperhidrosis: In medical terms, doctors use the word 'primary' to mean something caused by your body itself, or not caused by something external to your body. Primary hyperhidrosis is the general way to describe excessive sweating caused by something internal to the sweating process in our bodies, or the sweating itself, and not some other reason such as an underlying medical condition like an infection, or an outside variable like a medication causing a side effect of sweating.
• Secondary hyperhidrosis: In medical terms, doctors conversely use 'secondary' to describe a cause due to some other variable. In hyperhidrosis, this could be due to a side effect from a medication, or overheating from wearing too many layers, or more importantly a symptom of a more serious medical condition like a tumor, or an infection. To properly evaluate and treat for secondary excessive sweating, a doctor often first determines what (if any) underlying medical condition or medication may be the root of the problem, because the doctor wouldn't want to treat the hyperhidrosis while also masking or hiding the underlying condition.
• Focal hyperhidrosis: This primary type of hyperhidrosis occurs only in concentrated areas of the body, such as the face, palms of the hands, soles of the feet, groin or armpits. Typically, this type of sweating occurs on both sides of the body, meaning both hands, or both feet, or under both arms at the same time.
• Generalized hyperhidrosis: This secondary type of hyperhidrosis almost always relates to secondary causes of the excessive sweating, meaning from a side effect of a medication, such as medicines for dry mouth, or antidepressants. Usually, the sweating occurs all over the body, and can include sweating while sleeping.
• Palmar hyperhidrosis: Specifically, focal hyperhidrosis of the palms of the hands. Many studies have been conducted on the emotional as well as physical impact of this particular type of hyperhidrosis on the patient's life, especially socially.
• Plantar hyperhidrosis: Specifically, focal hyperhidrosis of the soles of the feet.
• Nocturnal hyperhidrosis: Most everyone has heard of 'night sweats' in their lifetime, either because they've experienced sweating at night firsthand, or heard someone else talking about night sweats. This sweating while sleeping is very common as part of a woman's menopausal years as shifts in hormones occur, but it's separately very important to distinguish the main cause of sweating at night from the environment. In other words, are you too hot from the blankets, room air, or general room temperature, or are you sweating at night due to something internal to your body, such as a fever breaking, or your body fighting an infection. Always seek the opinion of a medical doctor if you are experiencing unexplained night sweats
• Excessive sweating doesn’t have to be inevitable, and the skin doctors at SkyMD can help. Our dermatologists (skin doctors) can see you now, evaluate your excessive sweating, and create a treatment plan that fits your individual situation. Treatments can vary, and each patient should be individually evaluated. Common treatments are:
• Use stronger, prescription-strength antiperspirants, that may work at controlling your sweating better than the typical store-bought antiperspirants, or
• Use of one of several medical devices are on the market, such as home-use iontophoresis machines, a technology that combines with tap water to direct a small current through the skin, effectively neutralizing the connection between the nerves and the sweat glands, and
• In extreme cases, a doctor may even recommend surgery to either disconnect the nerves causing the overproduction of the excessive sweating or the removal of the sweat glands themselves.
• In all cases, a patient should never treat hyperhidrosis without the professional opinion of a medical doctor. Please read below for more details on hyperhidrosis symptoms, causes, treatments, and potential prevention.

SEE A DOCTOR

When your body excessively sweats, the symptoms are pretty simple and straightforward, because it's usually easy to determine if the sweating is tied to an increase in heat or from exercise, which would be normal. As mentioned above, the sweating happens either all over the body or in certain parts of it, like on the hands or feet, but symptoms differ between the two types of hyperhidrosis: primary and secondary hyperhidrosis.

Primary hyperhidrosis

Secondary hyperhidrosis

• excessive sweating in episodes once per week
• excessive sweating in specific parts of the body, such as the hands, feet, or underarm (axilla) areas.
• sweating that is symmetrical, meaning both sides of the body at the same time
• not sweating at night, while you are asleep
• sweating that you feel is affecting your daily activities, such as your social or work life
• excessive night sweats during sleep
• excessive sweating in more general parts of your body, or everywhere

Very important to note, a patient should understand that some excessive or sudden sweating can be a symptom of a more serious medical condition, and a doctor should be consulted immediately if a patient is experiencing other symptoms with the excessive sweating, such as nausea, chest pain, or lightheadedness.

First, let's talk about sweating, how your body naturally sweats, and why. Sweating, also known as perspiration, is something mammals do to help regulate their body temperature, primarily by producing liquid fluids in glands, called our sweat glands, and secreting them through our skin pores. Humans have two main types of sweat glands. Our eccrine glands are found all over our bodies, and their main job is to respond to help our bodies regulate heat by cooling through the effect of evaporation. Eccrine glands produce a clear liquid, primarily water, as a response to rising temperatures deep within the core of our bodies. Secondly, apocrine glands are found in limited locations on human bodies, such as under the arms (armpits or axillae), around the nipple or areola of our breasts, and even our eyelids! One strong correlation to tell them apart is that apocrine glands are found typically where their is hair. As primarily hairless mammals, human skin is mostly covered with eccrine glands helping us stay cool, or thermoregulated, while hairy mammals such as household pets like cats or dogs are covered in apocrine glands. So, as humans we sweat to thermoregulate, or stay cool, and we are very good at this task, as a normal size adult can sweat up to four liters per hour at peak, or up to fifteen liters per day! The more we use the muscles in our body, the more heat we generate, and the more heat we generate, the more we sweat! To understand what causes excessive sweating, we need to talk about the two types of hyperhidrosis: primary and secondary. Primary hyperhidrosis is a result of your body excessively sweating on its own. Secondary hyperhidrosis is a result of medical conditions or medications.

Primary hyperhidrosis

• Overactive nerves signaling sweat glands.

Secondary hyperhidrosis

• Medical Conditions - Several possible alternate medical conditions, like obesity, alcoholism or lymphoma, could cause excessive sweating.
• Medication side effect – Excessive sweating could be a side effect from the use of a large variety of medications.

Questions from Patients

• Why do I sweat so much?: Well, some sweating is normal, and we humans actually sweat all the time, but most of the time the sweat evaporates right away! Most often, we sweat because our body is cooling itself, regulating our internal temperature. We sweat more when we exercise, and may even sweat more when we experience different types of stress. Lastly, we may have problems with our normal biological sweating process. We may sweat too little, or sweat too much, and if over-the-counter antiperspirants don't control things, we should always consult a medical professional.
• What are night sweat causes?: There are many reasons why we sometimes experience night sweats, and the reasons vary quite a bit, so be sure to consult a doctor if you're not sure why you may be sweating at night. The simplest reason is you have too many clothes on, or bedding layers, or the room is too hot, or some combination of all three of these. Basically, shed some layers, or turn on the A/C! These are outer environmental reasons, and not true night sweats. But, if we are having night sweats from some internal process(es), we should take the time to determine why. Each of the following very diverse reasons requires a deeper analysis by you or your doctor, but the most common causes for non-environmental night sweats are: Infections, generalized hyperhidrosis, menopause, lymphoma, fevers or a fever that breaks in the night, side effects from medicines, hypoglycemia, or diabetes-related symptoms like low blood sugar or hypoglycemia.
• What is botox?: Botox is a drug made from a toxin produced by the bacterium clostridium botulinum. Working as a nerve block and a muscle paralyzer, the botox lasts a variety of months depending on the patient, and in the instance of excessive sweating has the added benefit of reducing it, since it also interrupts the sweat process. Botox can be a treatment option for focal hyperhidrosis, targeting the hands, underarms, face, or feet.
• Why am I sweating while sleeping?: For patients unfamiliar with night sweats, or hot flashes, see the above section related to those.
• What is the best deodorant for women?: We're not going to name or recommend brands here, but suffice it to say that what most women mean when they say best deodorant is best at preventing smelly body odor. So, look for two particular active ingredients to work as a team for you: an antibacterial agent, plus an antiperspirant. You may still sweat some, but the antibacterial agent will neutralize the smelly odors caused by the bacteria. And, look for a clinically strong antiperspirant containing aluminum salts, in particular aluminum zirconium tricholorohydrex. Check the product's label! The aluminum acts to block the work process of the sweat glands to reduce the amount of sweating. Prescription strength options are even available through your doctor.

Hyperhidrosis symptoms are fairly simple to identify, but treatment of excessive sweating can be much more complex due to the many potential underlying causes. Having a professional medical doctor determine the cause and type of sweating is important in receiving the most effective treatment options.

Home Remedies

While home remedies have taken on popularity, and patients certainly have access to unlimited online information about their health today, there are little to no studies confirming the effectiveness of home remedy treatments. In some cases, a home remedy might even do more harm than good considering their minimal effectiveness versus the unknown side effects they could have on your body. It’s best to follow the medical advice of a dermatologist because a medical professional will know what does or does not work in the treatment of the disease. At SkyMD, you can expect us to always be super conservative about recommending the use of any home remedy. Self-medicating or self-treating a medical condition is risky, and we always recommend consulting with a professional dermatologist about any excessive sweating you are experiencing. That said, several home remedies that you might come across while searching online are:

• Vinegar - Several reports can be found online for apple cider vinegar being a home remedy, supposedly helping to rebalance the pH levels in your body, but no medical articles (written by a medical professional) or studies have concluded that vinegar helps hyperhidrosis. More importantly, and as we mention above, you don't want to accidentally mask or hide a more serious underlying medical condition, when the hyperhidrosis could be a symptom of a more serious health issue.
• Salt - This one can easily confuse patients. As a home remedy, several online articles exist that reference common table salt, easy to find at home, as a home remedy for hyperhidrosis, but there is no scientific evidence of any positive results with table salt, or sodium chloride. BUT, another salt that medical professionals commonly use to treat hyperhidrosis is aluminum chloride. At low non-prescription strength levels, most over-the-counter antiperspirant products contain one or more varieties of aluminum chloride salts as the main active ingredient in preventing sweating. And, at higher dosages, prescription-strength medicines like Drysol, Hypercare or Xerac AC can be used to treat hyperhidrosis and all work off of the same mechanism using aluminum chloride salt.
• Coconut oil - Coconut oil contains an anti-bacterial agent called lauric acid, which is fine for eliminating the odor-causing bacteria in your sweat, and does technically make coconut oil a deodorant, but offers no help for the underlying cause of why you're sweating at all. A patient should not consider coconut oil as a home remedy to assist in the prevention of hyperhidrosis, but it may make you smell nicer!
• Lemon - Similar to coconut oil, lemon contains another anti-bacterial agent called citric acid, making lemons a mild deodorant through the neutralization of odor-causing bacteria, but lemon juice or citric acid does not assist in the treatment of or prevention of hyperhidrosis.
• Potatoes - Several online articles can be found claiming that rubbing potatoes under your arms, or on the areas of the body affected by excessive sweating, can help treat hyperhidrosis, but this is misleading. Potatoes are rich in potassium, and we need potassium in our diets. Potassium is one of our bodies' core electrolytes, but potassium is not an antiperspirant. Potassium and sodium play a paired role in maintaining healthy water balance in our cells and bodies overall. Sodium causes water retention while potassium tends to cause the opposite. Rubbing potato slices under your arms may absorb some of your sweat, but again, as many of these home remedies fail to do, potassium will not work as an active agent to affect the underlying cause of the excessive sweating.
• Sage leaves - First off, patients need to remember that sage is an herb, so consult your doctor before significantly changing the amount of sage your ingest, such as through teas, in case the sage could interact with other medicines in your body. Otherwise, sage is often cited as a home remedy for hyperhidrosis, either as a local topical applied directly to the affected area(s), or a food additive, and usually as a preventative or absorber of the moisture. But, sage does not penetrate the skin, so sage isn't going to do anything to your sweat glands to stop them from creating excessive sweat. However, dried sage could assist in absorbing some of the moisture, no different than a sponge, and sage could mask unpleasant sweat smells, since some varieties of sage do have nice smells. Ingested sage can spice up a nice food recipe, but there are no professional studies with findings where ingesting more sage had any positive effect on reducing excessive sweating.

Over the Counter Medications

While some over-the-counter (OTC) medications are effective, other OTC medications have limited effects on hyperhidrosis disease. They might help for mild to moderate cases, but they aren’t usually effective on severe cases of hyperhidrosis. If used incorrectly and without guidance, they might even prove to be ineffective and produce unforeseen side effects. However, a dermatologist can tell you whether or not these can be effective for you. As referenced above, some OTC medications that may or may not be included in a treatment plan given by one of our dermatologists are:

• Antiperspirants – Over the counter antiperspirants, especially with aluminum chloride salts, increases the antiperspirant effects.

Prescription Medicines

Prescription medicines, alongside professional medical advice, are the most effective form of treatment. Home remedies and over the counter treatments take plenty of time, energy, and money, yet are uncertain to work. Our experienced dermatologists take your unique skin issues, particular set of symptoms, and medical history into account to take the guessing game out of your road to recovery. Here are some prescriptions your dermatologist might include in your personalized treatment plan:

• Antiperspirants – Prescriptions may contain aluminum chloride hexahydrate which significantly increases the antiperspirant effects.
• Oral medication – Anticholinergics in these medications suppresses sweat glands.
• Iontophoresis Therapy - Iontophoresis is a technology that works by directing a small current through the skin, effectively neutralizing the connection between the nerves and the sweat glands. In nearly all cases, this effectively treats excessive sweating. A lot of research has been conducted on the effectiveness of tap water iontophoresis in the treatment of hyperhidrosis. Clinical studies have been performed on patients aged 8-71 years old with primary focal hyperhidrosis (mild, moderate, and severe). These clinical studies evaluated the efficiency of iontophoresis in both in clinical conditions (performed by healthcare professionals in a medical facility) and at home (patients were provided with devices and performed treatments on their own). The treatment parameters were similar in regards to the current strength, treatment duration, and treatment frequency. The studies found that 92% of patients saw results after two weeks of iontophoresis treatments, 88.9% of patients had positive results, a majority of the patients found the maintenance program compatible with their lifestyle, and that the quality of life improved in 78.6% of patients after two weeks. Your doctor would ultimately decide if iontophoresis treatments would be of any benefit to any one particular hyperhidrosis case, but tap water iontophoresis is a simple, safe and effective therapeutic option for palmoplantar hyperhidrosis.
• Endoscopic Thoracic Sympathectomy - A surgical procedure to treat sweating when excessive sweating occurs much heavier than normal. The palms or face are the most common sites on the body for this type of treatment, focusing on the sympathetic nerves that control sweating by cutting these nerves to the part of the body that sweats too much. Consult a doctor to determine if this more invasive treatment option is right for you.

Our dermatologists have resolved countless excessive sweating cases with medications and treatment plans that are proven to stop your discomfort once and for all. Trust dermatologists, the expert medical specialists on excessive sweating.

SEE A DOCTOR

After being seen by one of our SkyMD dermatologists, you will been equipped with a treatment plan and prescription(s) to treat your hyperhidrosis. However, the skin disease of hyperhidrosis can be persistent, so you have to be too. A skin care routine and a set of disease-preventing habits recommended by our dermatologists are essential for long term prevention. Here are some popular prevention strategies that could supplement your personalized treatment plan:

• Avoid heavy clothing trapping sweat, especially to help mitigate underarm sweat.
• Bathe or shower every day to prevent body odor